Radiation exposure and cost influence physician medical image decision making: A randomized controlled trial

Ronald W. Gimbel, Paul Fontelo, Mark B. Stephens, Cara H. Olsen, Christopher Bunt, Christy J.W. Ledford, Cynthia A. Loveland Cook, Fang Liu, Harry B. Burke

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND:: It is estimated that 20%-40% of advanced medical imaging in the United States is unnecessary, resulting in patient overexposure to radiation and increasing the cost of care. Previous imaging utilization studies have focused on clinical appropriateness. An important contributor to excessive use of advanced imaging may be a physician "knowledge gap" regarding the safety and cost of the tests. OBJECTIVES:: To determine whether safety and cost information will change physician medical image decision making. RESEARCH DESIGN:: Double-blinded, randomized controlled trial. Following standardized case presentation, physicians made an initial imaging choice. This was followed by the presentation of guidelines, radiation exposure and health risk, and cost information. RESULTS:: Approximately half (57 of 112, 50.9%) of participants initially selected computed tomography (CT). When presented with guideline recommendations, participants did not modify their initial imaging choice (P=0.197). A significant reduction (56.3%, P<0.001) in CT ordering occurred after presentation of radiation exposure/health risk information; ordering changed to magnetic resonance imaging or ultrasound (US). A significant reduction (48.3%, P<0.001) in CT and magnetic resonance imaging ordering occurred after presentation of Medicare reimbursement information; ordering changed to US. The majority of physicians (31 of 40, 77.5%) selecting US never modified their ordering. No significant relationship between physician demographics and decision making was observed. CONCLUSIONS:: This study suggests that physician decision making can be influenced by safety and cost information and the order in which information is provided to physicians can affect their decisions.

Original languageEnglish (US)
Pages (from-to)628-632
Number of pages5
JournalMedical care
Volume51
Issue number7
DOIs
StatePublished - Jul 1 2013

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Randomized Controlled Trials
Physicians
Costs and Cost Analysis
Tomography
Safety
Decision Making
Magnetic Resonance Imaging
Guidelines
Diagnostic Imaging
Medicare
Clinical Decision-Making
Radiation Exposure
Health Care Costs
Demography
Radiation
Health

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

Gimbel, Ronald W. ; Fontelo, Paul ; Stephens, Mark B. ; Olsen, Cara H. ; Bunt, Christopher ; Ledford, Christy J.W. ; Loveland Cook, Cynthia A. ; Liu, Fang ; Burke, Harry B. / Radiation exposure and cost influence physician medical image decision making : A randomized controlled trial. In: Medical care. 2013 ; Vol. 51, No. 7. pp. 628-632.
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Gimbel, RW, Fontelo, P, Stephens, MB, Olsen, CH, Bunt, C, Ledford, CJW, Loveland Cook, CA, Liu, F & Burke, HB 2013, 'Radiation exposure and cost influence physician medical image decision making: A randomized controlled trial', Medical care, vol. 51, no. 7, pp. 628-632. https://doi.org/10.1097/MLR.0b013e3182928fd5

Radiation exposure and cost influence physician medical image decision making : A randomized controlled trial. / Gimbel, Ronald W.; Fontelo, Paul; Stephens, Mark B.; Olsen, Cara H.; Bunt, Christopher; Ledford, Christy J.W.; Loveland Cook, Cynthia A.; Liu, Fang; Burke, Harry B.

In: Medical care, Vol. 51, No. 7, 01.07.2013, p. 628-632.

Research output: Contribution to journalArticle

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AU - Fontelo, Paul

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